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A three-judge panel of the U.S. Ninth Circuit Court of Appeals Monday released its decision that a 10 percent Medi-Cal outpatient fee-for-service rate cut, imposed by California from July 2008 through February 2009, was illegal because the state did not demonstrate that Medi-Cal patients’ access to services was equivalent to that of other patients. The 10 percent cut was replaced by a 1 percent cut in March 2009; in April of that year the Hospital Fee Program took effect, allowing hospitals to obtain reimbursement rates at or near the federal maximum.

CHA challenged the rate cut in 2008, and ultimately settled it as part of an overarching settlement involving other rate cases. However, a group of hospitals represented by a different law firm had separate litigation filed challenging the hospital outpatient rates, and continued with their case; these hospitals were deemed to have opted out of the CHA settlement. The case was sent back to the district court for further proceedings consistent with the Ninth Circuit’s opinion, which could range from issuing an order enjoining the state from implementing the rate cut to giving the government another opportunity to show that equal access existed. Regardless of the ultimate outcome, the decision is helpful to providers as it requires the state Medicaid agency to demonstrate equivalent access to care between Medi-Cal and other patients.

Today, Covered California released the attached proposed rates for the 2018 individual market, announcing that all 11 of its participating health insurance companies will return for the upcoming year. Covered California Executive Director Peter V. Lee said the average statewide rate change for 2018 will be a 12.5 percent increase, and noted that consumers can reduce that amount to less than a 3.3 percent increase if they shop for the best value and switch to the lowest-priced plan in the same metal tier. In addition, consumers will see federal subsidies rise, as they are tied to the price of the second-lowest-cost Silver plan. Those subsidies will help offset a significant portion of the rate change.

The rate change varies by health plan and region. Covered California notes that without the Affordable Care Act-mandated health insurance tax — a one-time increase of an average 2.8 percent — the average increase would have been less than 10 percent.

In the small hours of Friday morning, Sen. John McCain (R-AZ) cast the third Republican vote against the Senate’s plan to repeal the Affordable Care Act, defeating the so-called “Skinny Repeal” bill by a vote of 49-51. The measure, which would have repealed the individual and employer mandates, was the final offer by Senate Majority Leader Mitch McConnell (R-KY) to get the Senate to a conference with the House. Sen. McConnell indicated that he would move on to other issues. It is unclear what, if any, next steps are planned for the repeal/replace effort. The House is scheduled to begin its recess today.

Ways and Means Health Subcommittee Chairman Pat Tiberi (R-OH) has announced a new initiative to reduce legislative and regulatory burdens on Medicare providers. The “Provider Statutory & Regulatory Relief Initiative” will consist of three stages: receiving feedback from stakeholders, hosting roundtables with stakeholders across the country and taking congressional action based on stakeholder feedback.

The committee requests feedback from doctors, nurses, clinicians and health care professionals on how Congress can both deliver statutory relief from current mandates and work with Health and Human Services Secretary Tom Price, MD and Centers for Medicare & Medicaid Services Administrator Seema Verma to deliver regulatory relief through administrative action.

CHA will submit comments and encourages hospital members to do so as well. To submit comments by the Aug. 25 deadline, complete the attached form and send it to WMProviderFeedback@mail.house.gov.

In preparation for launching the Emergency Care Systems Initiative (ECSI), CHA and the Regional Associations are engaged in a variety of emergency department (ED) efforts across the state. Among the ongoing activities, CHA’s Emergency Services/Trauma Committee members are monitoring ambulance patient offload delays, as well as working closely with local emergency services authorities on performance improvement and technology enhancements to decrease transfer of care times. The Associations are also monitoring new developments with ED information exchange, including a promising new technology that identifies frequent utilizers and helps guide patient management across all participating ED sites through care coordination and case management.

To secure funding for ECSI, support letters have been sent to multiple stakeholders in the prehospital, public safety, payer and provider communities. Once funding is obtained, a consortium will convene to establish emergency services metrics and an emergency services report card to evaluate and improve services with ongoing systemic changes. In addition, local, regional and statewide advocacy will advance and accelerate ED services through a coordinated statewide approach. See the attached brochure for a detailed overview of ECSI.

Hospitals are encouraged to attend the Emergency Services Forum on Dec. 6 at the Riverside Convention Center in Riverside. For more information about ECSI, contact BJ Bartleson, vice president nursing & clinical services.

California hospitals are currently ranked in the bottom tier nationwide on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. In its examination of methods to improve these scores, the Hospital Quality Institute (HQI) analytics team found that a percent increase in response rate is predictive of a one-half percent increase in overall mean score. Therefore, HQI has set a target for hospitals to increase their overall response rate by at least 3 percent, which would advance statewide performance ratings to a score of 68 — and out of the bottom quartile. In California, response rates range from 8 to 60 percent. HQI urges hospitals with response rates of less than 25 percent to consider the following evidence-based recommendations:

News Headlines

In recent months, mothers who nearly died in the hours and days after giving birth have repeatedly told ProPublica and NPR that their doctors and nurses were often slow to recognize the warning signs that their bodies weren’t healing properly.

A study published Tuesday in MCN: The American Journal of Maternal/Child Nursing substantiates some of those concerns. Researchers surveyed 372 postpartum nurses nationwide and found that many of them were ill-informed about the dangers mothers face after giving birth.

The Trump administration, faced with increasing pressure from Republican members of Congress, backed away from causing an immediate crisis in healthcare marketplaces and agreed Wednesday to continue making payments to insurance companies that are widely viewed as critical to keeping the industry stable.

President Trump and his top aides have flirted for months with cutting off the money, known as cost-sharing reduction payments, which help subsidize insurance co-payments and deductibles for low-income and moderate-income Americans.

Women, in particular, have a lot at stake in the fight over the future of health care. Not only do many depend on insurance coverage for maternity care and contraception, they are struck more often by such diseases as autoimmune conditions, osteoporosis, breast cancer and depression. They are more likely to be poor and depend on Medicaid — and to live longer and depend on Medicare. And it commonly falls to them to plan health care and coverage for the whole family. Yet in recent months, as leaders in Washington discussed the future of American health care, women were not always allowed in the room.

Data breaches caused by hacking, so-called IT incidents and unauthorized access are on the rise, with 162% more incidents at healthcare organizations so far in 2017 as there were in all of 2016, according to data from HHS‘ Office for Civil Rights. Security experts said that’s because hacking has gotten easier and organizations are now reporting incidents they previously might have kept quiet about.

As a white nationalist rally in Charlottesville, Virginia, turned deadly on Saturday, doctors and public health leaders were among those watching events unfold on their television screens and social media.

Dr. Georges Benjamin, executive director of the American Public Health Association, was at a car dealership getting his vehicle inspected when he saw news reports of a car plowing into a group of counterprotesters. “I was horrified,” he said.

Dr. Elizabeth Samuels, an emergency physician in New Haven, Connecticut, and Providence, Rhode Island, was closely following the events in Charlottesville from home.

A mere three years after completing her residency training in 2011, surgeon Carla Haack found herself in the throes of job burnout. She had been devoting her life to the hospital, working 14-hour days including weekends for months at a time. Often the opportunity to eat a meal wouldn’t arise until the end of the long work day.

“You could have taken the textbook definition of burnout and stuck it on me. I was miserable, and the work became unsustainable for me,” said Haack, a general and acute care surgeon at Emory University Hospital. “I was exhausted, depleted and probably had some diagnostic features of depression.”

As a result of giving everything to the care of her patients, she ended up with nothing left for herself. Haack had even thought about leaving the practice. The combination of long hours, the increasing clerical demands of medicine and constant worries about patients’ health led to symptoms of burnout.

After years of criticism, nursing homes have curbed administering antipsychotics, but some providers are questioning whether the across-the-board cuts are preventing some seniors from getting needed medications.

The prevalence of use of antipsychotics among nursing home residents who have been in care for at least 100 days is 15.7% down in 2017 from 23.9% at the end of 2011, according to new data from the CMS. The reduction is due to a partnership between industry and the CMS in which nursing homes look for ways to reduce their reliance on the drugs. The National Partnership to Improve Dementia Care in Nursing Homes, which began in 2012, sparked by a report from HHS‘ Office of the Inspector General that found 83% of atypical antipsychotic drug claims were for elderly nursing home residents who had not been diagnosed with a condition for which antipsychotic medications were approved by the Food and Drug Administration.

Many young American surgeons have a strong desire to do humanitarian work overseas. But their good intentions usually don’t match up with the skills, such as cesarean section deliveries and fixing broken bones, that they’ll need in poor countries.

And that means U.S. general surgeons, eager to do charitable work around the globe, may miss out on chances to help some of the neediest patients in the world.

“I see all these young trainees,” says Dr. David Kuwayama, professor of vascular surgery at the University of Colorado School of Medicine. “They’re altruistic. They have open minds to the world, and they really want to do the work. But the opportunities for them to actually do it are becoming fewer and fewer.”

CHA recently redesigned its hospital disaster preparedness website, www.calhospitalprepare.org, to help California hospitals plan, prepare for and respond to the needs of victims of natural or man-made disasters, bioterrorism and other public health emergencies.

CHA’s Disaster Planning for California Hospitals Conference is the largest statewide program for hospital emergency preparedness professionals. Held Sept. 18-20 in Sacramento, it will provide an inside look at the recent shooting at the Bronx Lebanon Hospital Center in New York.

A new report from the American Hospital Association finds that hospitals and health systems spent an estimated $2.7 billion addressing community violence in 2016 and highlights significant work hospitals are undertaking to mitigate violence in the workplace and the community.

Carmela Coyle has been selected as the new President/CEO of the California Hospital Association and its parent organization, the California Association of Hospitals & Health Systems. Coyle will replace long-time CHA President/CEO C. Duane Dauner, who is retiring.

Learn

Education

September 18 – 20, 2017
Sacramento, CA

In a disaster, no one should have to go it alone. Working together with other hospitals, health care providers, community partners and government agencies can only strengthen a disaster response and ensure a smoother recovery. Build the partnerships that will power your readiness. Make plans today to attend the 2017 Disaster Planning for California Hospitals conference.

October 2017 – April 2018

Are you ready for your role in the new era of health care? The California Physician Leadership Program is a comprehensive educational program designed to challenge and grow physician leaders and medical executives. Participants will learn to assume greater leadership, serve as a driver of change and achieve better outcomes for patients.

Mission Inn Hotel & Spa, Riverside Convention Center

This three-day program will leave attendees feeling inspired and motivated to become “Agents of Change.” Day one focuses on behavioral health care policy and pressing issues. Day two is a blended format for both behavioral health care providers and ED professionals. Day three is focused solely on emergency medical care services issues and progressive practices to create future-focused ED care systems.

Throughout the year, CHA offers numerous programs designed to meet the needs of hospital executives. Whether you work in human resources, risk management, reimbursement, disaster planning or plant operations we are likely to have a program that will help you do your best for your facility.

Read

Publications

From basic principles to specific procedures, the Consent Manual is your one-stop resource for all legal requirements related to patient consent for medical treatment, release of medical information, reporting requirements and more. Learn exactly what the law requires and what you need to do to comply.

Overview

This comprehensive resource addresses all state and federal laws related to the privacy of health information, and provides guidance to help hospitals comply with increasingly complex regulations. Laws covered include:

CHA’s Hospital Compliance Manual is the only publication written for hospital compliance officers that integrates California with federal law on high-risk compliance areas. Written by Hooper, Lundy & Bookman, PC, and CHA, the manual focuses on high-risk compliance issues and the key components of an effective compliance program.

Overview

Who can legally give consent for treatment of a minor? Once a fairly simple question, the changing nature of families often complicates the answer. Providers must now frequently seek consent from separated or divorced parents, stepparents, foster parents, grandparents, guardians and other adults.